Fax to Assist - Module 3

The Stages of Change

Motivational Strategies
The 5 R’s for those Unready to Quit
Overview of Module 3
In this module you will learn about:

Stages of Change

Motivational Strategies

The 5 R’s

1. Stages of Change

The process of quitting smoking can be conceptualized as progressing through a series of stages of change.
Once individuals become dependent on nicotine, they seem to move and recycle through five stages on their way to achieving long-term abstinence from smoking.
Each of the stages represents important tasks that the smokers need to accomplish in order to successfully change.

2. Five Stages of Change for Smoking Cessation:

3. Stage of Change Tasks

Precontemplation

Awareness, Concern, Hope, Confidence

Contemplation

Risk-Reward Analysis & Solid Decision to Change

Preparation

Commitment & Creating an Effective/Acceptable Plan

Action

Adequate Implementation and Revising of Plan

Maintenance

Integration of New Behavior into Lifestyle

4. Stages and Smoking Cessation
The stages help to understand the temporal and motivational dimensions of smoking cessation.
The following figures offer a illustrative view of the entire process

Figure 1 shows the factors related to stage movement.
Figure 2 helps you to understand that it is not a linear process, but for most smokers, a cyclical one.

5. Figure 1. Theoretical and practical considerations related to movement through the Stages of Change.

6. Figure 2. Stages of Change Model

7. Cyclical Model for Intervention
Most smokers will recycle through multiple quit attempts and multiple interventions.
However successful cessation occurs for large numbers of smokers over time.

Keys to successful recycling

Persistent efforts

Repeated contacts

Helping the smoker take the next step

Bolster self-efficacy and motivation

Match strategy to patient stage of change

8. Helping Smokers in Early Stages of Change

Motivating smokers who are not ready to quit is always a challenge.
There are some new ways that have been developed to address smokers in Precontemplation, Contemplation, and Preparation Stages called Motivational Enhancement Strategies.

9. Motivational StrategiesMotivational approaches focus on providing:

Appropriate empathy

Personalized feedback

Positive reinforcement

Motivational strategies can:

Support self-efficacy

Promote autonomy

Be applied when clients are unready, unwilling, or unable to quit smoking

10. Addressing Barriers to Quitting

Motivational strategies can be effective even if a client does not want to quit.
Reasons for not quitting include: Misinformation, negative aspects of quitting (e.g., withdrawal), and prior unsuccessful attempts.
Motivational strategies can help clients make more informed choices, help overcome barriers to quitting, and have greater confidence about future quit attempts.
The 5 R's represent topics that are useful to address when helping smokers who are unready to quit move toward cessation.

The 5 R’s are: Relevance, Risks, Rewards, Roadblocks, and Repetition11. Relevance
Provide information that is relevant to the client’s situation, environment, and individual needs (e.g., health status, culture, and gender).
When providing individualized information, ask the client to identify how quitting is relevant to them and their loved ones.
Encourage the client to be as specific as possible.
12. Risks
Ask the client to identify negative effects of tobacco use; help identify which consequences are most important for the client.
Inform the client that smoking low-tar/low-nicotine cigarettes or using alternative forms of tobacco (e.g., smokeless tobacco or cigars) will not reduce potential consequences.
Address acute, long-term, and environmental risks associated with smoking.
13. Rewards
Ask the client to identify the benefits of quitting tobacco use, highlighting those most relevant for that individual.
Possible rewards include:

Better health for individual and individual’s family

Improved sense of smell and taste

Money saved

Improved self-esteem

Being a good role model to children and family

14. Roadblocks
Help the client identify any obstacles to quitting.
Some common roadblocks are:

Symptoms of withdrawal

Weight gain

Friends or family who smoke

Being afraid of failure

Lack of support

Discuss treatment options (e.g., pharmacotherapy and problem-solving) to help overcome roadblocks.
15. Repetition
Every time you have contact with a client who is smoking, you can address the 5 R’s.
It can be reassuring and motivating to share that many smokers will make several quit attempts before successfully quitting.
16. Summary of the 5 R’sRelevance: Help the client identify why quitting is relevant.
Risks: Encourage the client to verbalize possible negative outcomes of tobacco use.
Rewards: Have the client verbalize possible benefits of quitting tobacco use.
Roadblocks: Work with the client to identify obstacles to quitting.
Repetition: It may take more than one motivational intervention to help clients move toward a quit attempt.
17. Making an Impact on the SmokerKeys to success

Match interventions to the client’s stage of change

For those less ready, i.e., in Precontemplation and Contemplation, address the 5 R’s.

For those more ready, i.e. in Preparation help the client develop a quit plan.

For those who have successfully quit, i.e. in Action or Maintenance, discuss how to prevent relapse.

Increase the pros of quitting and cons of continued smoking.

Bolster self-efficacy and motivation to change.

YOU HAVE FINISHED MODULE 3.
Please CLICK HERE to proceed to MODULE 4, which covers: What your client will experience once contacted by the Maryland Quitline.

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